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Addiction In America: In Search Of A Fix

BRITISH MEDICAL JOURNAL

March 29, 2007

Can a series of quality documentaries undo the sensationalised image given by Hollywood to the issue of alcohol and drug addiction in the US? Chloe Veltman reports

Drug addiction is a problem that affects 23 million Americans, yet fewer than 10% are getting treatment. According the Centers for Disease Control and Prevention, drug overdoses are the cause of the second highest number of accidental deaths in the United States after car crashes, doubling between 1999 and 2004, from just over 11 000 to close to 20 000. With most people's views on drug addiction being shaped by over-sensationalised Hollywood films like Requiem for a Dream and Traffic—not to mention the media hoopla surrounding the drug induced death of ex Playboy model Anna Nicole Smith in early February—never has there been a greater need for a straightforward, high profile documentary series on the theme of drug addiction.HBO's new documentary film series, Addiction, ought to fill this much needed gap. Produced in partnership with the Robert Wood Johnson Foundation, the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the series sets out to explore the current state of drug and alcohol addiction in America through real life stories and views on treatment and recovery by drug and alcohol addiction experts. But despite the no nonsense approach aimed at educating viewers about drug addiction rather than shocking or entertaining them, Addiction leaves the viewer feeling as battered as a heroin user going cold turkey.

The series, which was premiered on March 15, is undoubtedly ambitious. It involves the collaboration of numerous filmmakers and medical experts across a broad range of themes and media. The centrepiece of the series is a 90 minute documentary that explores the drug and alcohol addiction landscape over nine short segments. Filmmaker Jon Alpert's opening sequence, Saturday Night in a Dallas ER, is an unflinching depiction of hospital staff dealing with several drug related injuries, from a deep arm wound sustained by a patient high on cocaine to an alcoholic's snapped ankle. Eugene Jarecki and Susan Froemke's The Science of Relapse, meanwhile, examines why addicts can't just "stop" taking drugs. By looking at the triggers in the brain that set off the craving state, the segment examines the potential use of medications like baclofen in recalibrating the brain's dopamine pathways. Elsewhere, The Adolescent Addict, a short film about teenage addicts, uses the real life stories of teens Dylan and Ted as a prism through which to discuss the causes of addiction in young people and the programmes available for treating this group.

The educational aspects of Addiction are comprehensive in scope. Supplementary short films and extended interviews with medical experts including Nora Volkow, director of NIDA, and Mark Willenbring, director of the treatment and recovery research division of NIAAA, provide an in-depth investigation of drug addiction related issues. The extensive online resources devoted to the project on HBO's main website further Addiction's outreach endeavours. Features include podcasts and information concerning such matters as "how to select a good treatment provider" and "five things you can do to enhance your recovery odds."

Yet despite—or perhaps because of—the targeted, highly practical nature of Addiction, the series makes for perhaps the least addictive programming put out by HBO in years. The project suffers most acutely from a bludgeoning case of didacticism. Repetition has long been viewed as a key component of the learning process. But the series' core message—that addictions are chronic diseases of the brain that can be managed through a combination of medical and behavioural treatments—is repeated so often, that it is rendered practically meaningless. Furthermore, the producers make little attempt to address opposing beliefs about the causes of —and treatments for—addiction. Coupled with its ham-fisted public service announcement tone, this single minded view of the subject makes Addiction, at times, border on propaganda.

The homogeneous look and feel of the individual segments only exacerbate the problem. HBO has hired some of the most acclaimed documentary makers working in the industry today for the project, including Academy Award nominated luminaries DA Pennebaker (The War Room) and Albert Maysles (Lalee's Kin). But traces of the filmmakers' particular styles are mostly absent from the finished product. In the main documentary, only Barbara Kopple's touching segment Steamfitters Local Union 638 about the efforts of members of a New York Steamfitters Union to ameliorate the pandemic alcohol problem among hard drinking workers reaches beyond the merely moralistic.